Pre‐Stroke Frailty and Lifestyle Factors Predict Functional Recovery after Endovascular Treatment in Vietnamese Patients With Ischemic Stroke

ABSTRACT Introduction Pre‐stroke frailty, often reflecting the cumulative consequences of lifestyle behaviors like physical inactivity and poor nutrition, is a known predictor of poor outcomes in acute ischemic stroke (AIS), but its role in Vietnamese patients undergoing endovascular thrombectomy remains unexplored. This study evaluates the association between pre‐stroke Clinical Frailty Scale (CFS) scores and functional outcomes at 1 and 3 months post‐endovascular thrombectomy in Vietnam. Methods In this prospective cohort study (2023–2024), consecutive AIS patients receiving EVT at a tertiary hospital in Vietnam were assessed for pre‐stroke frailty using the CFS. The primary endpoint was a favorable functional outcome at 90 days, defined as a modified Rankin Scale (mRS) score of 0–2. Multivariable logistic regression identified independent predictors, and receiver operating characteristic (ROC) analysis evaluated prognostic performance. Results Of 125 patients with a mean age 68 years, 70.4% achieved favorable outcomes (mRS 0–2). Frailty (CFS ≥ 5) present in only 2.3% of patients in the favorable outcome group compared to 27.0% in the poor outcome group ( p < 0.001). Median CFS was lower in the favorable outcome group (3 vs. 4, p < 0.001). CFS showed strong predictive accuracy, with areas under the curve (AUC) of 0.78 and 0.84 for favorable and excellent outcomes, respectively. Conclusion Pre‐stroke frailty, assessed via the CFS, is a simple yet powerful predictor of post‐EVT outcomes in AIS patients. Screening and addressing pre‐stroke frailty through lifestyle optimization may improve recovery. Therefore, routine frailty screening can enhance patient selection, inform prognostic discussions, and optimize the use of advanced healthcare in resource‐constrained settings.